| Doctor Name: | HEATHER J JOHNSON |
| NPI Number: | 1053631622 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | |
| Business Practice Address: | 15251 Pleasant Valley Rd Center City, MN - 550129640 |
| Business Phone Number: | 6512134286 |
| Business Fax Number: | |
| Mailing Address: | 15251 Pleasant Valley Rd, CENTER CITY |
| State: | MN |
| Postal Code: | 550129640 |
| Phone Number: | 6512134286 |
| Fax Number: | |
| NPI Enumeration Date: | 06/07/2010 |
| NPI Last Update Date: | 06/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |